Surgical site infection due to Mycobacterium wolinskyi after inguinal hernia surgery: A case report and review of the literature

TL;DR

This paper reports a rare surgical site infection caused by Mycobacterium wolinskyi after hernia surgery and reviews treatment strategies for similar cases.

Contribution

The paper presents a new case of mesh infection due to Mycobacterium wolinskyi and reviews treatment approaches for such rare infections.

Findings

Complete mesh removal was essential for controlling the infection.

Combination antibiotic therapy with fluoroquinolones and tetracyclines was effective.

Prompt surgical intervention can shorten the duration of antimicrobial treatment.

Abstract

•Surgical site infections caused by Mycobacterium wolinskyi are increasingly reported.•This case involved a rare postoperative mesh infection after laparoscopic hernia repair.•Complete mesh explantation was essential to achieve surgical source control.•Adequate drainage and debridement may allow for shorter treatment duration.•Fluoroquinolones, tetracyclines, and amikacin are commonly used in reported cases.

Surgical site infections caused by Mycobacterium wolinskyi are increasingly reported.

This case involved a rare postoperative mesh infection after laparoscopic hernia repair.

Complete mesh explantation was essential to achieve surgical source control.

Adequate drainage and debridement may allow for shorter treatment duration.

Fluoroquinolones, tetracyclines, and amikacin are commonly used in reported cases.

Mycobacterium wolinskyi (MW) is a rapidly growing mycobacterium that was first identified in 1999 using 16S rRNA gene sequencing. Although the number of reported cases of MW infection has been increasing in recent years, surgical site infections (SSIs) caused by MW remain rare, and standardized treatment regimens and durations have not yet been established. Herein, we report a case of SSI caused by MW after transabdominal preperitoneal repair intervention, along with a review of SSI cases caused by MW. An 86-year-old woman underwent transabdominal preperitoneal repair of an inguinal hernia with a synthetic mesh at another hospital. As the patient developed an SSI, drainage was performed; however, no pathogens were identified. At the the request of the patient, she was transferred to our hospital, and the infected mesh was removed. MW was isolated from the infected mesh. After completion of 24 weeks of oral minocycline and levofloxacin treatment, the patient was followed up for 1 year, and no recurrence was observed. We reviewed published cases of MW-associated SSI. All patients recieved a combination of antimicrobial therapies that involved two or more agents. Among the reported cases, fluoroquinolones were most frequently used (19 cases), followed by tetracyclines (15 cases). Our findings highlight that MW can be a potential causative organism of SSIs, particularly when routine cultures do not yield the typical pathogens. Prompt surgical intervention, including effective drainage, is crucial and can allow for a shorter duration of antimicrobial treatment.

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